Tuesday, January 13, 2009

AUSTIN – Texas lawmakers may be ready to force pharmaceutical companies to disclose payments to doctors, which some fear have led to excess prescribing of high-cost, high-risk drugs.

Mirroring a national trend, two state lawmakers have filed bills to require drug manufacturers to report all payments to Texas health-care providers – including consulting fees and honoraria, gifts and travel perks.

"There's a school of thought that doctors are prescribing expensive, higher-level drugs as a result of these drug companies – which throw elaborate dinners and provide them gifts," said Sen. Royce West, D-Dallas, who filed one of the bills.

"We want to make sure there is no inappropriate influence."

The bills, one of which would also apply to medical device manufacturers, follow several Dallas Morning News reports about Texas doctors' and researchers' relationships with drug companies. They would force the pharmaceutical firms to submit an annual list to the state of every payment or gift made to a doctor, pharmacist, hospital or nursing home.

Mixed reaction

While drug makers haven't yet taken a position on Texas' legislation – a replica of bills that are being considered in more than a dozen states – industry leaders remain wary. They say their relationships with doctors are key to educating the public about the latest effective drugs and technology.

The reporting requirements should not "inadvertently imply that these interactions are inappropriate," said Ken Johnson, senior vice president of the Pharmaceutical Research and Manufacturers of America. "These relationships are designed to ultimately benefit patients."

But groups that represent Texas physicians say they don't see a conflict.

Dr. Josie Williams, president of the Texas Medical Association, said her organization "supports transparency in health care, and favors transparency in this area as well."

The Texas bills are the latest addition to a national debate over the influence big pharmaceutical companies can wield over medical research and prescribing patterns.

Last summer, The News reported on the role drug companies played in funding a controversial state psychiatric drug list for children and for adults. One of the drug companies is the subject of a state lawsuit.

A U.S. senator investigating drug company influence on Harvard psychiatry researchers reported last fall that two University of Texas child psychiatry experts failed to report tens of thousands of dollars in income they received from pharmaceutical firms. The researchers had federal grants that required them to do so.

The senator, Iowa Republican Charles Grassley, is authoring a bill to create a national pharmaceutical disclosure registry – and to make it readily searchable on the Internet. Several states that have created local registries have struggled to make them public; pharmaceutical companies have claimed they contain trade secrets and are exempt from disclosure.

In the states that already have reporting requirements, "there's been a correlation between the amount of money pharmaceutical companies spend and the drugs prescribed by physicians," said state Sen. Rodney Ellis, the Houston Democrat who filed the other Texas bill. "It's appropriate to look at how much is being spent here."

Proposed penalties

Under the two Texas measures, companies that failed to list a payment to a health-care provider could be fined up to $2,500 per omission. Those that don't file a report could see penalties of up to $25,000.

Free samples of prescription drugs, student scholarships and gifts less than $25 in value would not need to be reported, and lawmakers say doctors would not be burdened with any paperwork.

Sen. Bob Deuell, a Greenville Republican who works as a primary-care physician, said that although he isn't on a drug company's payroll, he doesn't see anything wrong with doctors who are paid for their services. That said, he thinks the reporting requirements are appropriate.

If the funding is "all on the up and up, no one should even mind having the payments disclosed," he said. "I have no problem with it as a senator or as a doctor."

Doctors aren't the only ones receiving funding from pharmaceutical firms. Since 2007, Texas lawmakers and special interest groups have received a combined $700,000 in campaign contributions from drug companies seeking to influence legislation.